Acute pyelonephritis with renal vein and inferior vena cava thrombosis and pulmonary emboli in poorly controlled type 2 diabetes and HHS

Abstract

Renal vein thrombosis is a rare complication of acute pyelonephritis. We report a case of a 56‐year‐old woman with poorly controlled type 2 diabetes mellitus who presented with acute pyelonephritis and hyperglycaemic hyperosmolar state (HHS), complicated by thrombosis of the renal vein extending into the inferior vena cava. She was managed with intravenous antibiotics, intravenous fluids and insulin and with therapeutic low molecular weight heparin, despite which she developed pulmonary emboli two days after the diagnosis of renal vein and inferior vena caval thrombosis. Following optimisation of the dalteparin dose with factor Xa monitoring and a prolonged course of antibiotics, she made a full recovery. Two months post‐treatment there was resolution of the renal vein thrombosis and pulmonary emboli with improvement of inflammation of the right kidney on repeat computer tomography scanning. This case highlights the need to recognise renal vein thrombosis and pulmonary emboli as complications of acute pyelonephritis, especially in combination with poorly controlled diabetes mellitus, which further increases the hypercoaguable state. Copyright © 2016 John Wiley & Sons.